Sunday, May 12, 2013

Truth vigilantes, they aren't

Patients and parents concerned about mental illness have every right to be confused.

Stop referring to people experiencing psychological distress or exhibiting behaviors labeled abnormal or disruptive as “patients.”

The head of the federal agency that finances mental health research has just declared that the most important diagnostic manual for psychiatric diseases lacks scientific validity and needs to be bolstered by a new classification system based on biology, not just psychiatric opinion. The hitch is that such a biology-based system will not be available for a decade or more.

No, the hitch is that it won’t be available. The evidence compiled over the past 50 years leads to no other reasonable conclusion. There is a better possibility that Saddam Hussein’s WMDs are going to turn up. You should question Insel about why he holds such unwavering faith in the biopsychiatric model in the face of several decades of evidence that does not support it.

Dr. Thomas Insel, director of the National Institute of Mental Health, posted his critique of the manual in a “Director’s Blog”on April 29 and expanded on his reasoning in a recent interview with The New York Times. He was critiquing a forthcoming revision of the American Psychiatric Association ’s Diagnostic and Statistical Manual of Mental Disorders, the first major reissue since 1994. Although there have been controversies over particular changes in diagnostic descriptions, he said, the new revision involves “mostly modest alterations” from its predecessor.

This is important. It points to the fact that the problem goes deeper than this edition of the DSM.

The psychiatric association’s diagnoses are mostly based on a professional consensus about what clusters of symptoms are associated with a disease, like depression, and not on any objective laboratory measure, like blood counts or other biological markers. The mental health institute says scientists have not produced the data needed to design a system based on biomarkers or cognitive measures.

This isn’t something the institute “says.” It’s not a matter of opinion – it’s a claim of fact. It’s your job to investigate the truth of that fact claim, not simply to repeat it and then repeat contrary statements and spin. If you were to do so, you would find a hint in David Kupfer’s admission. You would find that he was compelled to make this admission at long last because the reality is that they don’t have the scientific evidence to support their diagnoses. The diagnoses lack scientific validity. The model is not supported by science. That’s quite a shortcoming.

You would also find that all of the hedging spin you typically, lazily repeat does not accord with the truth. The diagnoses aren’t “mostly” based on consensus. They’re not approximations, imperfect, or inexact. The problem isn’t diagnostic inflation or abuse, and it isn’t “overmedication.” It isn’t a lack of training in “proper” diagnosis. The core problem isn’t the medicalizing or misdiagnosing of the “normal.” The problem is that the diagnoses lack scientific validity. The model is not supported by science.

To fill the gap, the agency started a program two years ago to finance research in biology, genetics, neuroscience, cognitive science and other disciplines with the ultimate goal of helping scientists define disorders by their causes, rather than their symptoms.

There is no gap. There is a set of invalid diagnoses based on a false model.

The underlying problem is that research on mental disorders and treatment has stalled in the face of the incredible complexity of the brain.

It hasn’t stalled. Or slowed. Or stagnated. Scientifically, biopsychiatry has been a failure from the start.

That is why major pharmaceutical companies have scaled back their programs to develop new psychiatric drugs; they cannot find new biological targets to shoot for.

There are no old biological targets. There are no biological targets. There are decades of propaganda convincing people that there are biological targets, but there aren’t in fact biological targets.

And that is why President Obama has started a long-term brain research initiative to develop new tools and techniques to study how billions of brain cells and neural circuits interact; the findings could lead to better ways to diagnose and treat psychiatric illnesses, though probably not for many years.

There are better ways to understand and address psychological distress right now. Of course, it isn’t difficult to improve upon a false model. And stop referring to “psychiatric illnesses” and “symptoms” when the whole purpose of your editorial statement is to respond to the growing recognition that there is no scientific evidence of psychiatric illnesses.

Meanwhile, the diagnostic manual remains the best tool to guide clinicians on how to diagnose disorders and treat patients. Consensus among mental health professionals will have to suffice until we can augment it with something better.

Bullshit. Your job is not to prop up biopsychiatry or the pharmaceutical industry. It’s to find and report the truth. It’s bad enough that you’re stragglers in uncovering this epic medical and humanrights scandal. The least you could do at this point is grow some semblance of a journalistic spine.

*OK, I actually think it’s a good and worthwhile paper in many ways. But I’m angry at the moment.